Influência de um programa de exercício físico na remodelação cardíaca e na capacidade funcional de pacientes com acidente vascular cerebral
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Data
2022-01-13
Autores
Rodrigues, Josiela Cristina da Silva
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A reabilitação cardiovascular é uma das opções terapêuticas que vem sendo estudada em indivíduos pós-AVC para melhorar a independência funcional durante as atividades de vida diária e diminuir o gasto energético. Objetivos: Verificar o efeito de um programa de exercício físico sobre as variáveis ecocardiográficas morfofuncionais, capacidade funcional e variáveis relacionadas à função neurológica, pressão arterial, nutricional, laboratorial e qualidade de vida dos pacientes após AVC isquêmico. Métodos: Trata-se de um ensaio clínico, randomizado e controlado, composto por pacientes com AVC isquêmico em fase crônica, divididos em dois grupos: Grupo Controle (GC): submetidos ao atendimento fisioterapêutico convencional com exercícios três vezes por semana, por 45 minutos, durante 16 semanas, e Grupo Intervenção (GI): submetidos a um programa de reabilitação cardiovascular, composto por aquecimento, exercício aeróbico e resfriamento muscular, durante 16 semanas, três vezes por semana, durante 45 minutos. Os indivíduos foram submetidos inicialmente e após 16 semanas de intervenção, à avaliação clínica e física, teste de caminhada de 6 minutos (TC6), avaliação neurológica, nutricional, monitorização ambulatorial da pressão arterial (MAPA), exames laboratoriais, ecocardiograma transtorácico e avaliação da qualidade de vida. Resultados: Houve redução estatisticamente significante no GI em relação ao GC das seguintes variáveis ecocardiográficas morfológicas: diâmetro diastólico do ventrículo esquerdo (DDVE, p=0,04), diâmetro sistólico do ventrículo esquerdo (DSVE, p<0,01), espessura diastólica da parede posterior (PP, p<0,01), espessura diastólica do septo interventricular (SIV, p<0,01), espessura relativa da parede ventricular (ERP, p<0,01), massa do ventrículo esquerdo (MVE, p<0,01), índice de MVE (IMVE, p<0,01), diâmetro do átrio esquerdo (AE, p<0,01), diâmetro do ventrículo direito (VD, p<0,01) ao término da intervenção. Foi observado aumento estatisticamente significante no GI das variáveis de função sistólica do VE: fração de encurtamento do VE (delta D, p=0,01), fração de ejeção do VE (FE, p<0,01), velocidade de excursão sistólica do anel mitral ao Doppler tissular (Onda S, p=0,02), e de função sistólica do VD: velocidade de excursão sistólica do anel tricúspide ao Doppler tissular (Onda St, p<0,01) e excursão sistólica do anel tricúspide (TAPSE, p<0,01) quando comparado ao grupo controle após o período de intervenção. Também foi observado melhora estatisticamente significante da função diastólica do VE, sendo observado redução do índice do volume do átrio esquerdo (IVAE, p<0,01), aumento da razão entre as ondas E e A (E/A, p=0,02), aumento da velocidade de excursão diastólica do anel mitral ao Doppler tissular na fase de enchimento rápido (Onda E’, p<0,01) e redução da razão E/E’ (p<0,01) no grupo intervenção em relação ao controle após intervenção. Além disso, houve redução da relação cintura-quadril (p=0,01), melhora da qualidade de vida na dimensão dor/desconforto (p=0,01), melhora na força de preensão manual da mão sadia (p=0,01), aumento da distância percorrida (p=0,02) no grupo intervenção quando comparado ao grupo controle. Conclusão: O programa de reabilitação cardiovascular foi capaz de melhorar os parâmetros morfológicos e funcionais cardíacos, bem como apresentou repercussão positiva na capacidade funcional, força muscular, impacto metabólico com redução da relação cintura-quadril e melhora da qualidade de vida para dor e desconforto em pacientes com AVC isquêmico crônico. Trial registration: REBEC - RBR-4wk4b3. Registered 19 September 2016.
Background: Cardiovascular rehabilitation is one of the treatment options that have been studied in post-stroke individuals to improve functional independence in activities of daily life and reduce energy expenditure. Objectives: To evaluate the effect of an exercise program on the morphological and functional echocardiographic variables, evaluate the functional capacity and variables related to neurological function, arterial pressure, nutrition, laboratory exams and quality of life of patients after ischemic stroke. Methods: This is a clinical trial, randomized, controlled, and composed of patients with ischemic stroke in chronic phase divided into two groups: Control Group (CG) underwent conventional physiotherapy exercises three times a week for 45 minutes for 16 weeks; and Intervention Group (IG); undergo a cardiovascular rehabilitation program consisting of heating, aerobic and muscle exercise, for 16 weeks, three times a week, for 45 minutes. Patients in both groups will be submitted to clinical and physical evaluation, 6-minute walk test (6MWT), neurological assessment, nutritional assessment, ambulatory blood pressure monitoring (ABPM), transthoracic echocardiography and quality of life assessment. Results: There was a statistically significant reduction in the IG compared to the CG of the following morphological echocardiographic variables: left ventricular diastolic diameter (LVDD, p=0.04), left ventricular systolic diameter (LVSD, p<0.01), posterior wall diastolic thickness (PP, p<0.01), interventricular septum diastolic thickness (IVS, p<0.01), relative wall thickness (RWT, p<0.01), left ventricular mass (LVM, p<0.01), LVM index (LVMI, p<0.01), left atrial diameter (LA, p<0.01), and right ventricular diameter (RV, p<0.01) at the end of the intervention. A statistically significant increase was observed in the IG of the LV systolic function variables: LV fractional shortening (delta D, p=0.01), LV ejection fraction (EF, p<0.01), mitral annular systolic excursion velocity at tissue Doppler (S-wave, p=0.02) and RV systolic function: tricuspid annular systolic excursion velocity at tissue Doppler (St-wave, p<0.01) and tricuspid annular plane systolic excursion (TAPSE, p<0.01) when compared to the control group after the period of intervention. A statistically significant improvement in diastolic function was also observed, with a reduction in the left atrial volume index (LAVI, p<0.01), increase in the E/A ratio (E/A, p=0.02), increase in the mitral annular diastolic excursion velocity at tissue Doppler (E’ wave, p<0.01) and a reduction in the E/E' ratio (p<0.01) in the intervention group compared to the control after intervention. In addition, there was a reduction in the waist-hip ratio (p=0.01), an improvement in quality of life in the dimension pain/discomfort (p=0.01), an improvement in grip strength of a healthy hand (p=0.01) and an increase in the distance walked (p=0.02) in the intervention group when compared to the control group. Conclusion: The cardiovascular rehabilitation program was able to improve morphological and functional cardiac parameters, as well as positively impacting functional capacity, muscle strength, metabolic impact with reduced waist-hip ratio, and improved quality of life for pain and discomfort in patients with chronic ischemic stroke. Trial registration: REBEC - RBR-4wk4b3. Registered 19 September 2016.
Background: Cardiovascular rehabilitation is one of the treatment options that have been studied in post-stroke individuals to improve functional independence in activities of daily life and reduce energy expenditure. Objectives: To evaluate the effect of an exercise program on the morphological and functional echocardiographic variables, evaluate the functional capacity and variables related to neurological function, arterial pressure, nutrition, laboratory exams and quality of life of patients after ischemic stroke. Methods: This is a clinical trial, randomized, controlled, and composed of patients with ischemic stroke in chronic phase divided into two groups: Control Group (CG) underwent conventional physiotherapy exercises three times a week for 45 minutes for 16 weeks; and Intervention Group (IG); undergo a cardiovascular rehabilitation program consisting of heating, aerobic and muscle exercise, for 16 weeks, three times a week, for 45 minutes. Patients in both groups will be submitted to clinical and physical evaluation, 6-minute walk test (6MWT), neurological assessment, nutritional assessment, ambulatory blood pressure monitoring (ABPM), transthoracic echocardiography and quality of life assessment. Results: There was a statistically significant reduction in the IG compared to the CG of the following morphological echocardiographic variables: left ventricular diastolic diameter (LVDD, p=0.04), left ventricular systolic diameter (LVSD, p<0.01), posterior wall diastolic thickness (PP, p<0.01), interventricular septum diastolic thickness (IVS, p<0.01), relative wall thickness (RWT, p<0.01), left ventricular mass (LVM, p<0.01), LVM index (LVMI, p<0.01), left atrial diameter (LA, p<0.01), and right ventricular diameter (RV, p<0.01) at the end of the intervention. A statistically significant increase was observed in the IG of the LV systolic function variables: LV fractional shortening (delta D, p=0.01), LV ejection fraction (EF, p<0.01), mitral annular systolic excursion velocity at tissue Doppler (S-wave, p=0.02) and RV systolic function: tricuspid annular systolic excursion velocity at tissue Doppler (St-wave, p<0.01) and tricuspid annular plane systolic excursion (TAPSE, p<0.01) when compared to the control group after the period of intervention. A statistically significant improvement in diastolic function was also observed, with a reduction in the left atrial volume index (LAVI, p<0.01), increase in the E/A ratio (E/A, p=0.02), increase in the mitral annular diastolic excursion velocity at tissue Doppler (E’ wave, p<0.01) and a reduction in the E/E' ratio (p<0.01) in the intervention group compared to the control after intervention. In addition, there was a reduction in the waist-hip ratio (p=0.01), an improvement in quality of life in the dimension pain/discomfort (p=0.01), an improvement in grip strength of a healthy hand (p=0.01) and an increase in the distance walked (p=0.02) in the intervention group when compared to the control group. Conclusion: The cardiovascular rehabilitation program was able to improve morphological and functional cardiac parameters, as well as positively impacting functional capacity, muscle strength, metabolic impact with reduced waist-hip ratio, and improved quality of life for pain and discomfort in patients with chronic ischemic stroke. Trial registration: REBEC - RBR-4wk4b3. Registered 19 September 2016.
Descrição
Palavras-chave
Acidente vascular cerebral, Ecocardiograma, Atividade física, Independência funcional, Qualidade de vida, Stroke, Echocardiography, Physical activity, Functional independence, Quality of life